We do not inject a level until a block has told us it is the right one

PRP FOR THE SPINE AND SACROILIAC JOINT

Most of this website is about tendons and joints in the limbs. The spine is different enough to deserve its own page, mostly because it is where the temptation to inject something without knowing what hurts is strongest.

The problem with the spine specifically

In a knee or an elbow, the painful structure is usually identifiable by examination and ultrasound. In the back it frequently is not. Discs, facet joints, the sacroiliac joint, muscle, and referred visceral or hip pathology all present through overlapping patterns, and imaging findings are common in people with no symptoms at all.

Which means the honest starting position is that we usually do not know which structure is generating your pain, and neither does anyone who tells you confidently after a ten-minute appointment and a scan.

What a diagnostic block does

A small volume of local anesthetic is placed, under fluoroscopic guidance, at one specific structure. If that structure is the pain generator, the pain goes away for the duration of the anesthetic. If it does not, that structure has been ruled out.

It is the closest thing to a direct answer available in spinal medicine, and it is why the rule here is simple: we do not inject a level until a block has told us it is the right one. An orthobiologic placed at the wrong level is not a treatment that failed. It is a treatment that was never aimed.

Where the sacroiliac joint fits

The sacroiliac joint is the most defensible spinal-region target on this site. It is accessible, it can be confirmed with a block, and ligamentous laxity around it is a plausible mechanism for a biological treatment to address.

It is also chronically over-diagnosed, because buttock pain has a long differential. Gluteal tendinopathy, lumbar referral, hip joint disease and the sacroiliac joint itself all produce pain in roughly the same place, and only one of them responds to what we inject here. Gluteal tendinopathy is the most common impostor.

What we will not do

• Intradiscal injection without a confirmed target. We do offer it, and only for axial discogenic pain that has been established rather than inferred from a scan. Discitis is the risk that governs how carefully it is selected — see PRP for the disc.
• A series booked in advance. If the first block does not identify a target, the plan changes rather than continues.
• Treating a scan. Degenerative findings are near-universal past middle age and are not, on their own, an indication for anything.
• Injecting through an unexplained neurological deficit. Progressive weakness or numbness needs a surgical opinion, not a biologic.

Where the answer is not an injection at all

A substantial share of chronic back pain involves central sensitization — a nervous system that has changed how it processes signal from the region, independent of what the tissue is doing. No injection reverses that, and treating it as though it were a structural problem produces years of procedures and disappointment.

That is not a way of saying the pain is imagined. It is a statement about which mechanism is running, and it changes what works: graded loading, sleep, behavioral work delivered properly, and the metabolic terrain that keeps inflammatory tone high. Those are treatments, not consolation.

How we proceed

• Assessment. History, examination, review of imaging against the examination, and an honest statement of what is and is not known.
• Diagnostic block where a specific structure is suspected and the answer would change management.
• Treatment only where the block was positive, and only where a biological target makes sense.
• Loading and behavioral work throughout, not afterward.

If that sequence sounds slower than being offered an injection at the first visit, it is. It is also the difference between treating your pain and treating a picture of your spine.

Where this sits against pain medication

The spine is where opioid escalation most often begins, because the pain is constant, the diagnosis is uncertain and the procedures frequently disappoint. Nobody here will require a taper as a condition of being assessed, and nobody will imply the dose is a character question. What we will do is refuse to sell a series of injections into an unidentified target, because that pattern — repeated procedures, partial relief, rising dose — is how people end up worse than when they started.

What people ask about the spine and SI joint

Will you inject my disc?

No. The evidence is poor and the risks are real. What we treat and what we decline.

Why do I need a block before treatment?

Because otherwise nobody knows which structure to aim at. How we assess.

My buttock hurts. Is that my sacroiliac joint?

Often it is the gluteal tendons instead, and the treatments differ completely. Gluteal tendinopathy.

Is this covered by insurance?

Diagnostic blocks sometimes are; the orthobiologic is not. Why.

What the block itself involves

Fluoroscopic guidance, local anesthetic at the skin, and a small volume placed precisely. It takes minutes. You are asked to keep a simple record of your pain over the following hours, because the answer is in the duration of relief rather than in how it felt in the room.

A block that relieves the pain for the expected life of the anesthetic and no longer is a positive result. One that relieves it for three days is telling you something different — usually about the inflammatory contribution — and one that does nothing has ruled a structure out, which is a useful outcome rather than a wasted procedure.

Why we are more conservative here than most

Because the spine punishes confidence. Imaging findings are near-universal past middle age; the pain generator is frequently unidentifiable; central sensitization is common and does not respond to structural treatment; and the procedures are lucrative enough that the incentive runs the wrong way.

Arthroscopic partial meniscectomy for degenerative tears, subacromial decompression, and vertebroplasty were all widely performed on mechanistic reasoning before anyone compared them against a sham. All three failed that comparison. That history is a reason for humility about every procedure on this website, including ours.

What we want you to leave with

If the honest answer is that your back pain has no identifiable structural target, the plan is graded loading, sleep, behavioral work delivered properly in-house, and the metabolic terrain — and that plan is not a downgrade from an injection. It is the treatment with the better evidence for that presentation.

Questions worth asking before any spinal injection

• Which specific structure do you believe is generating my pain, and what established that?
• Has that structure been confirmed with a diagnostic block?
• What is the plan if the block is negative?
• How many of these would you do before concluding this is not working?
• What are we doing about load, sleep and the metabolic picture alongside this?

The fourth question is the one that separates a plan from a series. A clinic that cannot name a stopping point has not designed one.

Related reading

• Injury and work comp
• Gluteal tendinopathy
• PRP for the disc
• PRP for the facet joints
• Platelet lysate
• Am I a candidate?
• Opioid stewardship
• How PRP works

The sacroiliac joint has the thinnest evidence base of any target on this site, and that is true of its risk factors as much as its treatments. There is no sacroiliac-specific dataset quantifying metabolic contribution that we would be willing to quote. The disc has one and it is on the discogenic pain page; here the assessment is the same but the honest claim is smaller.